Inspection on 02/07/07 for The Roan Rest Home

This inspection was carried out on 2nd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Roan Rest Home 27/06/08

The Roan Rest Home 23/05/06

The Roan Rest Home 22/11/05

The Roan Rest Home 08/06/05

The Roan Rest Home 13/10/04

The Roan Rest Home 25/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Roan Rest Home 27/29 Pembroke Crescent Hove East Sussex BN3 5DF Lead Inspector Jennie Williams Key Unannounced Inspection 2nd July 2007 12:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Roan Rest Home Address 27/29 Pembroke Crescent Hove East Sussex BN3 5DF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01273 772927 01273 738260 Roan@vigcare.co.uk Mr Joginder Singh Vig Mrs Beant Kaur Vig Mrs Beant Kaur Vig Mr Balbir Roy Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is nineteen (19) Service users must be older people aged sixty-five (65) years or over on admission 23rd May 2006 Date of last inspection Brief Description of the Service: The Roan Rest Home is a residential care home providing social and personal care for up to nineteen older people. There are four rooms allocated to provide intermediate care. The home is owned by Mr and Mrs Vig who owns numerous care homes throughout the South of England, predominantly older people services. The Roan Rest Home is situated in a quiet residential area of Hove within walking distance of local amenities. There is nearby access to public transport. There is no parking available at the home, but two hour restricted paid parking is available in adjacent streets. Accommodation is provided over three floors in a large property that has been converted from two houses. A passenger lift enables residents to access all parts of the home. However, there is a short flight of stairs to mezzanine levels and the dining room that place some limitations on residents with restricted mobility. The home would not be suitable for wheelchair users. Seventeen rooms are for single occupancy, of which eleven have en suite facilities and one double room that does not have en suite facilities. There is a lounge/dining room on the lower ground level and a quiet lounge on the first floor. This quiet lounge is used as an office and for use by residents. There are suitable numbers of communal toilets and bathing facilities located throughout the home. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Weekly fees range between £305 and £411. There are additional fees; hairdressing (£6.50 - £25), Chiropody (£9), newspapers and personal toiletries (at cost). This information was provided to the CSCI on the 30th June 2007. . A copy of the most recent inspection report is available at the home. Residents/relatives know about the service through social service referrals, word of mouth and from living in the area. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed to the Inspector that people who use this service are called residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced key site visit took place over seven and a half hours on the 2nd July 2007. Seven residents were spoken with individually throughout the inspection process. Two care plans were viewed and specific areas of care were looked at in a further three care plans. Four visitors were spoken with during the site visit. One Registered Manager, Mrs Vig, deputy manager and three other care staff members were spoken with. Three staff files were viewed to assess the recruitment procedures within the home. There are two Registered Managers for this home who share the responsibilities within the home. For the purpose of this report where the Registered Manager is referred to, it pertains to Mrs Vig who facilitated this inspection. A tour of the environment was undertaken and some individual rooms were viewed. Medication procedures were inspected. The quality assurance system was discussed and recent results viewed, complaint and Safeguarding Adult procedures and records were viewed. Copies of the staff rota were provided and menus were viewed. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. There were fourteen residents residing at the home on the day of the site visit. What the service does well: The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. Prospective residents are provided with opportunities to visit the home prior to moving in to ensure the home will meet their needs. The pre admission process ensures that only those residents whose needs can be met at the home are admitted. Care plans provide guidance to staff on how to meet the assessed needs of residents. Residents were complimentary about the staff working at the home The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 6 and felt that their personal care needs were being met. Residents felt that their privacy and dignity are respected. Routines of daily living are generally to the individual’s choice and preference. Activities are provided at the home that is within an individual’s choice, interest and ability. Visitors are welcomed at the home and residents may receive visitors in private. Residents found their rooms to be comfortable and the home was free from offensive odours. There are suitable communal facilities provided to meet the needs of residents residing at the home. Residents are generally safeguarded by the recruitment procedures in place. Residents are encouraged to control their own money or make other arrangements with friends/family. The home does not hold money for individuals. What has improved since the last inspection? What they could do better: The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 7 The Statement of Purpose/Service Users Guide needs to be amended to provide clear information on the limitation the environment may pose for individuals. This is to ensure that individuals prior to admission make an informed decision. Care plans need to be implemented and reviewed with the resident or representative to ensure that choice and preference are taken into account. Work is needed to be undertaken to ensure residents receive a varied wholesome and appealing balanced diet and provided with choice to ensure that individual preferences and specialist diets are catered for. Nutritional assessments need to be undertaken to ensure that any specialist needs are catered for and advice sought when needed to promote and maintain good nutritional status of individuals. Staffing numbers must be kept under regular review to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health, safety and welfare of residents. Records required by regulation must be maintained and available at the home for inspection to ensure residents rights and best interest are safeguarded. The home must consult with a fire safety expert to ensure that there are adequate fire safety procedures in place to ensure the health, safety and welfare of all people within the home. Any action identified must be addressed. Other minor shortfalls noted, which have not been reflected as a requirement or recommendation have been noted throughout the inspection report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make a decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: Prospective service users/representatives are provided with a Statement of Purpose and Service Users Guide that provides them with information on the services and facilities provided at the home. These documents should identify to prospective residents that some rooms and the dining/lounge room can only be accessed by steps that residents must be able to step up and down these independently. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 10 The Registered Manager or deputy manager undertakes the pre admission assessments of all prospective residents who are being admitted for respite or long-term placement. The Registered Manager confirmed that an additional assessment is undertaken on a resident if they have spent a period of time in hospital. Residents spoken with who are long-term placements confirmed that they or a representative visited the home prior to moving in. Residents admitted for intermediate care do not always have an opportunity to visit the home prior to their short-term placement. An intermediate care resident confirmed that they had not received any information about the home prior to moving in. The Statement of Purpose identifies that the first four weeks are accommodated on a trial basis. Pre admission assessments were unable to be viewed for two recently admitted residents. The Registered Manager confirmed that assessments had been undertaken, however the documents pertaining to the homes assessment was unable to be located on the day of the site visit. Management must ensure that these documents are kept securely and made available for inspection. It was confirmed that an assessor from the Intermediate Care Team undertakes assessments for the intermediate care residents. This information is sent to the home where the Registered Manager and deputy manager will make a decision from this information if the persons needs can be met at the home. Staff spoken with confirmed that they felt that all residents currently residing at the home are suitably placed and all their needs are being met. Appropriate action is taken if residents needs become too much for the home to continue meeting their needs. It was confirmed that there was no one residing at the home from any minor ethnic community, social/cultural or religious groups with any specific needs or preferences. The AQAA identifies that internal training is provided to staff to ensure they understand the concept of equality and diversity. There are specific rooms that are contracted for intermediate care residents. Due to the passenger shaft lift not servicing all areas of the home, the location of the rooms available are taken into account when deciding if an individual should be admitted. It was confirmed by the Registered Manager and on speaking with residents that good support from the intermediate care team is provided regularly eg: physiotherapy, occupational therapists and district nurses. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans provide information on the assessed needs of residents, however staff are not familiarising themselves with these on a regular basis and the reviewing process does not ensure that individual choice and preferences are taken into account. Residents are safeguarded by the medication procedures in place. EVIDENCE: There is no key worker system in place and the deputy manager develops the care plans. Staff confirmed that they do not have any involvement in the care plans, however they do read them when a resident is first admitted and are kept up to date on residents changing needs during handover period between shifts. They do not look at care plans on a regular basis. The deputy manager confirmed that care plans are reviewed on a monthly basis, however there is no involvement with the residents/representatives to ensure their choice and The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 12 preference is taken into account. It is advised in the Statement of Purpose/Service Users Guide that residents/representatives will be involved in the care planning process. Some residents spoken with confirmed that staff do not discuss their care with them and they are not familiar with their care plans. It was discussed with the deputy manager that risk assessments in place could be expanded to clearly identify the risk and document any action to take to reduce these risks. It was recommended that the management of the home access training to undertake regarding risk assessments. Intermediate care residents have good access to visiting health professionals as part of the contracted arrangements between the local authority and the home. Other long-term residents spoken with confirmed that they have access to dental, hearing and eye tests when required. A GP visits the home on a weekly basis. Medication Administration Records (MAR) charts viewed demonstrated that medication is generally being signed for at the time of administration. It is recommended as good practice that any handwritten prescriptions are double signed by staff who have undertaken medication training. The pharmacist has given advice to the home on the storage of controlled drugs. As a safety measure, the home has still opted to record and sign for a medicine, despite the supplying pharmacist advising that they did not need to do this. It was recommended at the site visit that controlled drugs be recorded on pages in a numbered page book. It was confirmed that there are policies and procedures in place for all aspects of dealing with medicines. The content of these were not read. The AQAA identifies that risk assessments are undertaken for residents who wish to self medicate and that they are provided with lockable facilities. It was confirmed that the supplying pharmacist undertakes yearly reviews of the medicines used at the home for individuals and discusses them with the residents. Residents spoken with confirmed that staff respect their privacy and dignity. Staff were observed to knock on residents doors prior to entering and were heard to be calling them by their preferred term of address. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is generally their own choice. The provision of meals needs to improve to ensure preferences and choice is catered for. EVIDENCE: There is an activity co-ordinator employed for four hours in the afternoon on a Tuesday and Thursday. The majority of residents spoken with confirmed that there were sufficient activities provided at the home if they choose to be involved. Cards, Dominoes and Bingo are some of the activities provided. A couple of residents thought that more stimulation could be provided. It was confirmed by staff that residents are not interested in participating in arranged activities. A recent outing arranged for residents had to be cancelled due to poor response by the residents. Most residents spoken with confirmed that their lifestyle within the home is their own choice and choose their own bedtimes, to participate in activities and The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 14 what clothing to wear etc. Some residents will independently go out into the community and staff will assist less independent residents to visit local amenities. A resident spoken with confirmed that staff encourage and promote their independence. It is recommended that it is reflected within an individuals care plan their preference to bathing. A resident confirmed that they are offered a bath once a week and stated that when they request an additional one, they are informed that there are not enough staff working to have an additional bath. This was discussed with the Registered Manager and deputy manager on the day of the site visit. Visitors spoken with confirmed that there are no visiting restrictions at the home and they are always welcomed by staff at any time. Residents are able to see visitors in private if they wish. The regular cook has recently left employment and there is a temporary cook from another of the provider’s home working until a replacement is found. The Registered Manager confirmed that they are currently recruiting for a cook. Residents spoke positively about the food until the regular cook left employment. The majority of residents confirmed that the standard in the food has decreased. Comments regarding the food ranged from ‘very very nice but now not so nice’, ‘not good at catering for diabetics’, ‘food was beautiful’, ‘you can name the day of the week by the food provided’ and ‘sometimes I don’t know what I’m eating’. One resident commented to the Inspector that they do not like tomatoes, however it was served to them on the day of the site visit. It was confirmed that the cook has a list of residents likes/dislikes/allergies in relation to food, however management must ensure that this is up to date and provided to the cook to ensure that individuals preferences are catered for. Three weeks of menus were viewed and these identified that there was not a great variety between the different weeks. Any meal provided that differs from the main meal is recorded. There were mixed responses regarding if there is a choice of meals provided, however most residents confirmed that they are provided with a choice at suppertime. Some residents stated that ‘some days there is a choice’ and other comments were ‘you eat what is put in front of you’. One resident confirmed that their breakfast is brought to them early in the morning at their request. There was fresh fruit noticed being provided in the communal lounge. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents feel comfortable to complain, reassuring them that they are being listened to and that action will be taken, if necessary. Staff have received training in Safeguarding Adults to ensure residents are safeguarded and appropriate action taken in the event of an allegation being made. EVIDENCE: The home has a complaints procedure in place and of the residents that were asked, all stated that they would know who to speak to and would feel comfortable to make a complaint. There has been one complaint made to the home in the last 12 months. This was referred to the owners by CSCI to investigate. It was relating to the insufficient numbers of staff on night duty. The Registered Manager confirmed that she had risk assessed all residents and there was no need identified to increase staffing levels. She confirmed that she keeps staffing numbers under review. The home found this complaint to not be upheld. It was recommended to the Registered Manager and deputy manager that records be maintained of all complaints, even when they are received verbally from residents. Records should be maintained of these and to identify if any action was taken as a result of their investigation. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 16 There is a Safeguarding Adults procedure in place and a Protection of Vulnerable Adults (POVA) flow chart available for staff to follow in the event of an allegation of abuse being made. The Registered Manager and staff spoken with all confirmed that they have received Safeguarding Adults training. There was one Safeguarding Adults raised regarding three residents admitted for intermediate care. Two related to psychological abuse and the other was related to poor care following a fall at nighttime. A decision was made by the purchasing authority to remove these three residents from the home. Other Safeguarding Adults allegations were of verbal abuse and lack of care provided from a carer. One was substantiated and there was insufficient evidence found to substantiate the other. The AQAA identifies that that there have been no POVA referrals made in the last 12 months. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with suitable facilities. Further redecorating and refurbishments are needed within the home ensure residents reside in a wellmaintained environment. EVIDENCE: The home is located in a quiet residential area of Hove. Residents spoken with are happy with their individual rooms. Rooms randomly viewed were seen to be personalised to reflect the individuals’ choice and personality. Rooms are located over three floors. There is a passenger shaft lift that accesses all floors, however does not service the mezzanine levels. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 18 Staff and some residents spoken with felt that the three steps to access the dining/lounge area causes some difficulty and may restrict the movement of some residents. Residents must also be able to independently mobilise to access rooms/communal facilities that may be located in areas that are not serviced by the passenger shaft lift. One visitor spoken with confirmed that their relative had been located upstairs and this location was not assisting in them remaining independent. It was confirmed that this individual was transferred to a room on the lower ground. There is a call bell system in all rooms at the home. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. One of the three baths is assisted. Residents must be able to access the baths independently for the other two baths. There is a wheel in shower that residents have access to. The AQAA identifies that there are policies and procedures in place for infection control and that seven staff have received training on the prevention of infection and management of infection control. It was observed during the tour of the environment that cleanliness within the home could be improved. Areas that management need to ensure attention is paid to are extractor fans, shower head, bases of divan beds and some carpets are stained/old and worn. The Registered Manager confirmed that carpets are cleaned on a regular basis and the beds are gradually being changed. The AQAA identifies in ‘what we could do better’ is to develop a formalised maintenance programme and involve residents by asking their opinions of the rooms and communal areas. There were no offensive odours noted on the day of the site visit. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents needs are being met with the skill mix of staff on duty, however may not always be safeguarded by the number of staff working at night. Residents are generally safeguarded by the recruitment procedures. EVIDENCE: Residents were complimentary about the staff working at the home. Comments received about the staff ranged from ‘good’ to ‘brilliant’. Some staff spoken with confirmed that at present, with the current level of needs of residents, that there were sufficient numbers of staff on duty. Some comments received from both staff and residents confirmed that there could be more staff in afternoons and there are concerns regarding only one staff member working a night shift. Excluding management, there are usually three care workers working in the mornings, two carers in the afternoon and one care worker at night. It was noted at the site visit and confirmed by speaking with staff that one of carers in the afternoon cleans the kitchen and prepares suppers, leaving one The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 20 care worker to meet the needs of all the residents. It was confirmed that it is restrictive in the afternoons if there is an admission. Some staff spoken with are concerned regarding only one staff member working at night. They are concerned that if a resident has a fall, there is no hoist available at the home and they do not have anyone to assist them. Following a Safeguarding Adults investigation regarding a fall of a resident, the Registered Manager confirmed that a falls policy has been put in place. Staff are concerned that if more than one resident is ill or has an emergency ‘who do I go to first?’. There is an on call system, where one manager lives within close proximity to the home, whilst another on call person lives 15 to 20 minutes away. The Registered Manager confirmed that two care staff have completed National Vocation Qualification (NVQ) level 2 and four are currently doing NVQ level 3. The deputy manager has completed NVQ level three in care and has just completed the Registered Manager Award course. The AQAA identifies different statistics in relation to staff qualifications than what the Inspector was informed. Further work is needed to ensure that 50 of care staff obtain NVQ level 2 or above qualifications. No requirement has been made in respect of this as action is being taken to address this shortfall. This standard will continue to be assessed throughout the inspection process. Staff files viewed demonstrated that there are generally good recruitment practices in place to ensure residents are safeguarded. One staff file had no commencement date and no evidence of POVA First or Criminal Record Bureau (CRB) having been obtained. It was confirmed that all relevant checks have been undertaken for this individual and that all staff are supervised until a full CRB check is returned. Management must ensure all documentation is available for inspection. It was discussed with the Registered Manager that further information be obtained regarding dates of previous employment and any gaps in employment explored. One staff’s visa had expired, however it was confirmed that this had been renewed. The Registered Manager confirmed that she will ensure that a copy of the renewed visa is kept at the home. No requirement has been made in respect of recruitment procedures and this will continue to be monitored throughout the inspection process. The AQAA identifies that all people who have worked in the home in the last 12 months had satisfactory preemployment checks. Staff spoken with confirmed that they are kept up to date with mandatory training and are provided with plenty of training opportunities. Some of the recent training undertaken are: food and hygiene, manual handling, POVA and medication training. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 21 The Registered Manager and deputy manager confirmed that there is an induction programme in place. There were no records at the home to view in relation to induction. It was recommended that the Registered Manager ensures that the induction programme at the home complies with the Common Induction Standards and meets the Skills for Care expectations. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37 & 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and staff are supported by the management structure in the home and the home is generally run in the best interest of residents. The health, safety and welfare of residents and staff could be better promoted and protected. EVIDENCE: There are two Registered Managers at this home who share the responsibilities of managing the home. Staff spoken with were complimentary about the management of the home and confirmed that they are approachable and supportive. Neither of the Registered Managers has undertaken any The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 23 management qualifications. The deputy manager has just completed her Registered Manager Award course and it is proposed that this person will put forward an application to the CSCI to become the Registered Manager. It is not reflected as an outstanding requirement that the Registered Manager undertakes relevant managerial qualifications as there is action being taken to address this shortfall. This will continue to be monitored for compliance throughout the inspection process. The home has a quality assurance and quality monitoring system in place. Questionnaires are provided to residents on a six monthly basis. Staff and resident meetings are held every two to three months and minutes of these meetings are maintained. A comment observed to be written by a resident was ‘Thank you for looking after me so well during my brief stay her. You have all been most kind and helpful and cheerful’. Written comments from other stakeholders were: ‘ The standard of care I have witnessed during my time is very high’ and ‘a very family orientated environment’. It was discussed with management that results are analysed and displayed at the home for residents and other people visiting the home to read. The home does not hold any personal allowances for residents. Residents manage their own finances or have arrangements in place for family or other representatives to assist them with their finances. A system for providing supervision to staff has just been implemented. The content of these were not read, however it was noted that some were not dated or signed by the staff member. The deputy manager confirmed that she has received appropriate training during the Registered Manager Award course to provide supervision for staff. Some staff spoken with confirmed that they have not received any supervision. This is not reflected as a requirement or recommendation as work is being done to address this shortfall. This will continue to be monitored throughout the inspection process. There were thermostatic controls noted to be installed on hot water outlets that residents have access to. Radiators were observed to be guarded or confirmed they were of guaranteed low surface temperature. The fire risk assessment was unable to be located on the day of the site visit. A document was shown to the Inspector, however this was only guidelines as to what a fire risk assessment should contain. The Registered Manager confirmed that a fire risk assessment had been undertaken. Fire doors were noted to be wedged open, even in rooms where no one was residing or noted to not shut securely. The Registered Manager confirmed that she has been advised that they can be fined for allowing this practice to occur. A fire exit on the top floor was out of use due to the exit platform not being safe. It was confirmed that quotes have been obtained to have this repaired. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 24 Fire training is undertaken and it was confirmed that fire drills are held at the same time of the training. It was confirmed that fire drills have not been undertaken for night staff. It was observed that a regular night staff member had not had an update in fire training since July 2005. A new staff member working nights commenced work two months ago. This individual has not had any fire training, however it was confirmed that the procedures were explained during their induction. The CSCI held a meeting with the registered providers in February 2007 regarding having only one staff member on night duty and that this was unsatisfactory regarding fire and safety. Mr Vig responded that he could not afford to have more than one staff on at night. This was again confirmed at the site visit with the Inspector being informed that the home is not financially viable to have an additional member of staff working at night or to install dorguards to all doors where residents wish them to remain open. It was confirmed that management has got individual residents to sign a form to advise that they wish their doors to remain open. This practice is not suitable. Due to the level of concerns regarding fire practices and safety within the home, the Inspector contacted the local fire authority the day after the site visit to advise them of the concerns. Management must ensure that they seek professional advice regarding fire safety practices within the home. No other health and safety records were viewed. The AQAA identifies that any equipment used at the home has been serviced or tested as recommended by the manufacturer or other regulatory body. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 2 1 The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement Timescale for action 30/08/07 2. OP7 15 3. OP15 12(2)(3) 16(2)(i) 4. OP27 18(1)(a) That the Statement of Purpose/Service Users Guide be amended to provide clear information on the limitation the environment may pose for individuals. This is to ensure that individuals prior to admission make an informed decision. That care plans are implemented 30/08/07 and reviewed with the service user or representative to ensure that choice and preference are taken into account. That service users receive a 10/08/07 varied wholesome and appealing balanced diet and provided with choice to ensure that individual preferences and specialist diets are catered for. Nutritional assessments are to be undertaken to ensure that any specialist needs are catered for and advice sought when needed to promote and maintain good nutritional status of individuals. That staffing numbers are 10/08/07 regularly reviewed to ensure that at all times suitably qualified, competent and experienced DS0000014253.V339033.R01.S.doc Version 5.2 The Roan Rest Home Page 27 5. OP37 17 6. OP38 23(4) persons are working at the care home in such numbers as are appropriate for the health, safety and welfare of service users. That all records required by regulation are maintained at the home to ensure service users rights and best interest are safeguarded. Timescale 01.07.06 not met. That following consultation with a fire safety expert that there is adequate fire safety procedures in place to ensure the health, safety and welfare of all people within the home. 30/08/07 10/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations That any hand written prescriptions are checked and signed for by two staff who are trained in medication procedures, to ensure residents and staff are safeguarded from errors being made. The Roan Rest Home DS0000014253.V339033.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!